- Iron deficiency is the most common cause of anemia worldwide.
- Anemia is present in adults if the hematocrit is below 41%(hemoglobin less than 13.6 g/dL [135 g/L]) in males, or
- Below 36% (hemoglobin less than 12 g/dL [120 g/L]) in females.
What is the Daily requirement To make good average daily loss, iron requirements are:
- Adult male. : 0.5- 1 mg (13 µg/kg)
- Adult female : 1- 2 mg (21 µg/kg) ( menstruating)
- Infants: 60 µg/kg
- Children: 25 µg/kg
- Pregnancy (last 2 trimesters) : 3 – 5 mg (80 µg/kg)
What is CAUSES OF IDA
most important cause for iron deficiency anemia nowadays are iron deficient diet.
other causes are..
- Decreased absorption due to any disease like ..
– Autoimmune gastritis or Celiac disease[ poor absorption in the GIT]
– Helicobacter pylori gastriti
– Hereditary iron-refractory iron deficiency anemia and Zinc deficiency
- Increased requirements in case of Pregnancy and Lactation
- Chronic blood loss [ most important cause in adults] through gastrointenstinal tract ,Menstrual, blood donation and chronic Hemoglobinuria etc.
Reason of Gastrointenstinal blood loss is any parasite infection ,for example hookworm
- Iron sequestration in case of Pulmonary hemosiderosis
- Idiopathic
Symptoms and signs……..
- The primary symptoms of iron deficiency anemia are those of the anemia itself (easy fatigability, tachycardia,palpitations, and dyspnea on exertion).
- Severe deficiency causes skin and mucosal changes including. -a smoothtongue
– brittle nails
-spooning of nails (koilonychia)
– cheilosis
- Dysphagia due to the formation of esophageal webs (Plummer-Vinson syndrome) may occur in severe iron deficiency.
- Many iron-deficient patients develop pica,craving for specific foods (ice chips, etc) often not rich in iron.
TREATMENT
Dietary sources of iron
Rich source of iron : Liver, egg yolk, oyster, dry beans, dry fruits, wheat germ, yeast.
Medium source of iron : Meat, chicken, fish, spinach, banana, apple.
Poor source of iron: Milk and its products, root vegetables.
Oral Iron( Iron pills)
some simple oral preparation are……
1. Ferrous sulfate, 325 mg once daily or every other day on an empty stomach, is a standard approach for replenishing iron stores.
Ferrous sulfate have maximum iron concentration so most likely it is prefer by the doctors
2. Ferrous g luconate ( 12% iron)
3. Ferrous fumarate (33% iron)
4. Colloidal ferric hydrox ide (50% iron)
5. Carbonyl iron
Parenteral iron…..
- If Oral iron is not tolerated and Failure to absorb oral iron ,
- Non-compliance to oral iron, and In presence of severe deficiency with chronic bleeding, and
- Along with erythropoietin in chronic kidney disease (CKD)
Iron therapy by injection is indicated only when:
1 . If Oral iron is not tolerated
by the anemic person because in many people iron pills cause vomiting and nausea .
2. Failure to absorb oral iron( reasons are…..
- malabsorption due to inflammatory bowel disease or
- Chronic inflammation(e.g. rheumatoid arthritis) decreases iron absorption, as well as the rate which iron can be utilized. )
3. Non-compliance to oral iron.
4. In presence of severe deficiency with chronic bleeding in patients.
5. Along with erythropoietin in chronic kidney disease (CKD) patients.
In healthy people’s erythropoietin synthesis occur in kidney but in case of chronic kidney disease patients are not able to synthesis of erythropoietin.
So, in iron deficient person with chronic kidney disease require erythropoietin along with iron.